肾细胞癌伴静脉癌栓的诊治(附6例报告)

The management of renal cell carcinoma with vena cava involvement

目的 :提高肾细胞癌 ( RCC)伴静脉癌栓的诊治效果。方法 :1996～ 1999年诊治 RCC伴静脉癌栓 6例 ,其中肾静脉型 1例 ,肝下型 3例 ,膈上型 2例 ,经磁共振成像 ( MRI)及彩色多普勒超声确诊 ,均行肾癌根治术加癌栓取出术。结果 :肾静脉型平均生存 36个月 ;肝下型 3例分别生存 2 5个月、4个月 (有局部淋巴结转移 )及 2 2个月 ,最终均死于远处转移 ;膈上型 1例 (伴肺转移 )术后 2个月死于远处转移 ,1例右心房癌栓者在取出癌栓开放血流时因呼吸及循环衰竭而死亡。结论 :MRI和彩色多普勒超声检查是目前诊断 RCC伴静脉癌栓的较好方法 ;对无淋巴结和远处转移者 ,手术应采取积极的态度 。

Purpose:To study the diagnosis and treatment of renal cell carcinoma(RCC) with vena cava involvement. Methods:From 1996 to 1999, 6 cases of RCC with venous involvementthe,tumor thrombi being renal type in 1, infrahepatic type in 3, supra diaphragm type in 2, were reviewed. Radical nephrectomy with extraction of the emboli was undertaken in all 6 patients.Results:1 patient of renal type has been alive for 36 months. 3 patients of infrahepatic type and 1 patient of supradiaphragm type have been alive for 25, 4, 22, 2 months respectively, died of metastases. Conclusions:Venous involvement in RCC could often be detected on MRI and doppler ultrasonography. More aggressive surgical strategy is recommended for RCC with venous involvement.